Press Release  Lowell Adult Day Health Provider Resolves Allegations of Falsely Billing Masshealth

Boston — A Lowell-based adult day health provider has agreed to pay more than $200,000 to the state’s Medicaid program (MassHealth) to resolve allegations that it inappropriately billed for services not provided, Attorney General Maura Healey announced today.

The settlement with ADH Seller, LLC (formerly New England Adult Day Health, LLC) d/b/a New England Community Care, LLC (NECC) resolves allegations that the company submitted claims to MassHealth that overstated the amount of time certain members were actually receiving services.

“This company allegedly defrauded the MassHealth program by intentionally billing for services that were never provided and diverting resources from those in need,” AG Healey said. “Our Medicaid Fraud Division is dedicated to investigating fraud and abuse and will continue to pursue bad actors to recover taxpayer dollars that help fund legitimate services and claims submitted to MassHealth.”

In September 2014, NECC was sold to Civitas Solutions, Inc. The AG’s Office began an investigation after the amount of billing for the daily rate was allegedly substantially lower under Civitas’ management than when NECC ran the facility.

The AG’s investigation revealed that between August 2012 and September 2014, NECC inappropriately billed a daily rate for services to particular members when the company actually provided less than a full day of services.

Adult day health centers provide activities of daily living or skilled nursing services to MassHealth members suffering from medical or mental dysfunctions requiring nursing care, health assessment, oversight, monitoring or services provided by a licensed nurse. Members visit the facility to receive these services and providers are permitted to bill for services in 15 minute increments up to six hours, or at a daily rate if the member is present at the facility for more than six hours. 

The AG’s Office alleges that NECC overbilled MassHealth for the amount of services provided to certain members over the two-year period. Based on these allegations, NECC agreed to resolve this matter by paying $225,000 to MassHealth. The company is no longer in business.

This matter was handled by Assistant Attorney General Lee Hettinger and Investigator Lisa Bailey of AG Healey’s Medicaid Fraud Division.

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